Organization
LOWELL FAMILY DENTAL PRACTICE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KONSTANTIN V AMIRZADOV DMD (PRESIDENT)
(978) 458-1179
Entity
Organization
Contact information
Practice address
133 MARKET STREET, LOWELL, MA 01852-1808
(978) 458-1179
(978) 805-1415
Mailing address
133 MARKET STREET, LOWELL, MA 01852-1808
(978) 458-1179
(978) 805-1415
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
18197
MA
1223G0001X
General Practice Dentistry
21444
MA
1223G0001X
General Practice Dentistry
21536
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9727230
—
MA
01
—
X11619
BLUE CROSS BLUE SHIELD
MA
Enumeration date
02/26/2007
Last updated
08/22/2020
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